Article review: Failing at feedback in medical education

Most of the medical education literature on feedback is teacher-focused rather than learner-focused. In other words, focus is paid towards teaching faculty how to give feedback which:

Is non-judgmental

Is non-threatening

Is specific

Consists of both positive and constructive elements

Offers alternatives

However, successful feedback requires not only a skilled feedback giver but also an environment conducive to feedback discussions and a willing feedback receiver. I imagine a feedback session as a discussion between two friends on cell phones. There has to be someone talking, adequate cell phone reception (more than just 1 bar), and someone actively listening. If any of these elements are missing, communication breaks down.

This commentary article in JAMA's annual medical education edition discusses why feedback isn't working as well as it could. Areas that could be improved can be broken down into three areas:1. The teacher: Learning to give feedback is an essential skill in faculty development. Often teachers are so subtle in their giving of feedback, that the learner doesn't realize that feedback is going on! A neat trick is to preface your feedback comment with: "Here's a little feedback for you..." It is amazing how much more feedback students feel like they are getting.

2. The environment: A crowded Emergency Department is a tough environment to give feedback. Ideally, you should find an area where your comments can be given privately. Don't humiliate the learner. This provides the learner with a safe place to voice their concerns, questions, and thoughts.

3. The learner: The article focuses a lot on this particular topic of improving feedback reception. It is human nature to want to hear positive feedback, and different people respond differently to negative feedback. Some go into denial, and some react with a negative emotion. These preclude the learner from actually gaining any useful feedback from the interaction.

Have you noticed that students who require the MOST amount of improvement are some of the LEAST receptive to constructive feedback? They unfortunately lack self-reflection and insight into how little they know.

In addition to continued faculty development programs to teach how to give feedback, medical schools should also focus on teaching students (1) to recognize feedback, (2) how to practice reflection and self-assessment, and (3) how to incorporate negative feedback without being defensive.